Provider Demographics
NPI:1205841657
Name:WEN-HONG FELIX PENG, DDS, INC.
Entity Type:Organization
Organization Name:WEN-HONG FELIX PENG, DDS, INC.
Other - Org Name:PLAYA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENHONG
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-313-1063
Mailing Address - Street 1:4740 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5824
Mailing Address - Country:US
Mailing Address - Phone:310-313-1063
Mailing Address - Fax:310-437-5200
Practice Address - Street 1:4740 INGLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5824
Practice Address - Country:US
Practice Address - Phone:310-313-1063
Practice Address - Fax:310-437-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9222601Medicaid